Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
* Children's Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
JOB SUMMARY
We are seeking an experienced and motivated Data Architect to design the enterprise data lake and warehouse foundations, standardize claims, members and providers data models, and ensure governed, secure, high-quality data flows that supports Operations, Regulatory Reporting, and Member/Provider experience within Community Health Choice.
This individual will also be responsible for ensuring data quality, management, and compliance. He/she will work closely with key stakeholders to promote a culture of data-driven decision-making across the organization. This leadership role will be responsible for building cross-functional relationships, educating stakeholders, and partnering with data, applications, and analytics teams to ensure data standards adhere to industry best practices and help to deliver rapid impactful benefits. He/ She will also represent Information Technology in enterprise projects including data platform modernization, business transformation, and AI enablement.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Architecture and Framework
Establish and enforce organizational data strategy and create high-level designs for data architecture frameworks.
Define and maintain the enterprise data architecture (data lake + warehouse), reference architectures, and integration patterns (batch/real-time).
Establish canonical data models for Member, Provider, Claims, Enrollment/Eligibility, Authorizations/UM, Encounters, Pharmacy and Finance.
Create a roadmap for interoperability (FHIR/HL7, X12 837/835/834/820, CMS Patient Access/Provider Directory APIs)
Data Integration and Flows
Define and manage data flow and integration architecture, ensuring data can be accessed and moved efficiently across various platforms and systems.
Design efficient ELT/ETL pipelines (CDC, orchestration, partitioning) across Microsoft Fabric (Lakehouse, Warehouse, Pipelines) and Azure Data or other modern data platforms.
Analytics, ML & AI Enablement
Enable actuarial, quality, and clinical use cases (HEDIS, risk adjustment, care management) with curated, performance-tuned datasets.
Prepare architecture for ML/AI.
Data Modeling & Design
Design and develop data models, blueprints, and databases to store and retrieve company data effectively.
Lead dimensional/semantic modeling for Power BI.
Publish domain data products with SLAs, quality rules, lineage, and documentation.
Data Governance
Assist in the development and execution of CHC's enterprise data governance operating model with a focus on data quality management, stewardship programs, and Master Data Management implementation
Define and enforce policies, standards, and controls for CHC's enterprise data platform, including data quality, master and reference data, metadata, and lineage
Establish a scalable data stewardship model, coordinating across business unit leaders and data domains to assign clear ownership and accountability
QUALIFICATIONS: Required
Education/Specialized Training/Licensure:
Bachelor's degree in information management, Healthcare Administration, Engineering or a related field required.
Work Experience (Years and Area):
7+ years in data/application/architecture/engineering with at least 3 years in healthcare payer or provider data environments.
Expert in data modeling and proficient with Data Vault 2.0 concepts.
Delivered BI/semantic models for tools like Power BI; tuned for performance and cost.
Ability to influence and drive change within a cross-functional team and organization.
Software Proficiencies:
Microsoft Office (Word, Excel, PowerPoint, Teams, and Outlook)
Expert Knowledge of SQL Query, SQL Server, Data Integration tools
Expertise in database systems (SQL, NoSQL), data modeling, cloud platforms (AWS, Azure, Google Cloud), data warehousing and lakes, programming languages (Python, Java, SQL), and data security and governance. Understand ETL processes, data pipelines, and data lifecycle management
